The CHI is a new initiative that was established in October 2016 that aims to enhance the healthcare system through improved continuity of care, a more satisfying patient experience and measurably better value by embedding a set of continuous improvement principles, behaviours and tools within its management system.

Currently in its first phase, the CHI initiative will primarily focus its work in a “Model cell,” or a referral axis from community-based services to tertiary hospitals, with particular emphasis on the management of diabetic patients across these facilities.

The health facilities involved in this initial phase are Retreat Community Health Centre, Victoria Hospital and Groote Schuur Hospital. To ensure sustainability, a primary objective is to develop capacity via skills enhancement and to modify behaviour of staff working in these facilities. The project encourages staff to apply the improvement methodologies in their routine work, with a view towards improving care for patients with diabetes mellitus.

The learning and experiences from these first phases will then be applied to the rest of the services. The CHI Team consisting of four core members – Dr Stephan Fourie, Dr Heather Tuffin, Dr Gavin Reagon and Dr Kirsty Bobrow – are therefore working with numerous stakeholders and staff in the model cell involved in diabetic care.

The value of lean in public healthcare

In South Africa, about 50% of total health expenditure is spent on 84% of the population in the public sector. Service and budgetary pressures are part of the daily realities facing those working in the public sector. Therefore lean and improvement science methodologies are important in sustaining quality and cost effective public healthcare services.

Besides improving value for money, the lean methodology can create balanced improvements by simultaneously increasing patient safety and the quality of services they receive, and by enhancing the patient experience and staff satisfaction within the current available resources.

The WC DoH is collaborating with the Lean institute Africa (LIA) to provide expert advice and support to the CHI initiative, as well as support a range of specific improvement projects at Groote Schuur Hospital.

The primary activities of the CHI project to date have been to capacitate staff to apply the lean and improvement methodologies in their routine work. The staff will start the service model projects in September 2017, which will focus on creating increased value for patients in terms of safety, quality of the services as well as an improved patient experience. This is in line with the Department’s aim to provide more comprehensive care, improve the patient experience and improve health outcomes by reducing long term complications from diabetes.

Empowerment through continuous improvement

It is important to keep in mind that we, as project leads of the CHI initiative, truly have to respect the people that we’re engaging with: respect their basic humanity, respect the daily struggles, and respect the fact that they have been working diligently to improve their own and their patients’ environments long before we came onto the scene. It’s also important to respect the fact that they want to improve as much as we do. So much of the success lies in the mutual respect and building trust with our people.

We ask staff to think about their day: what they planned to do coming in to work and what actually happened. Very quickly staff can describe the mismatch and can recognise waste – we just give it a name. We are offering a way for teams to move through the obstacles between what is and where we want to be. Staff immediately understand what we are talking about because it’s their daily struggle. We have found that playing games is an excellent method to simulate the reality of leaner process because this concrete experience gives them the confidence to try new things.

By giving staff the means, the authority and the space to do their work well, we empower them. By doing this consistently, we create new energy and new found self-confidence to make positive change. If we keep on repeating this, we see a continuous improvement. One way or the other, we need both if we are going to overcome some of the intractable issues facing healthcare.

Developing as healthcare leaders

The second Lean Healthcare Summit taking place in September is particularly special because it offers a space where everyone is passionate about not only lean but healthcare. We’re hoping that we can create relationships and learning networks with other like-minded people and really take healthcare by (benevolent) storm.

Amidst all the challenges and shrinking budgets within healthcare, the lean methodology becomes an important driver of creativity, innovation and change. It helps us to stretch our minds and skills to embrace new ways to cope with the many challenges.

Dr Stephan Fourie and Dr Heather Tuffin will both be speaking at the Lean Healthcare Summit 2017: Empowering Healthcare Professionals Through Continuous Improvement, which will be taking place on 7th September 2017 at The Forum, Johannesburg. The one-day event will inspire the South African healthcare community by demonstrating the benefits of using lean management in healthcare, and motivate those already adopting lean management. More information about the event can be found here.

Dr Stephan Fourie is a Medical Doctor and also holds an MBA from Stellenbosch University. He has more than 11 years’ experience working in the WC DoH, which includes serving as the Medical Manager for Red Cross War Memorial Children’s Hospital as well as the Provincial Clinical Operations Coordinator. Currently, as Director in the WC DoH, he is involved with numerous specialised projects in the Western Cape. One of these projects is the newly established CHI initiative that drives lean healthcare in the WC DoH.

Dr Heather Tuffinis a Medical Doctor turned improvement scientist. She works with staff in the Western Cape provincial health system to improve patient care processes, with the joint aims of improving health outcomes and creating a greater level of joy in the workplace. She has recently been appointed as Project Manager for the newly formed CHI office for the WC DoH. She is an honorary lecturer for the faculty of Emergency Medicine at UCT, where she teaches Patient Safety and Improvement Science as part of their Masters programme.